Hideki Hondo

Computed Tomography Controlled Aspiration Surgery for Hypertensive Intracerebral Hemorrhage

To overcome the disadvantages of conventional surgery, we developed our own method of computed tomography controlled stereotactic aspiration surgery for hypertensive intracerebral hemorrhage. A new ultrasonic surgical aspirator was also developed to facilitate aspiration of a dense clot in the acute stage. Between 1980 and 1988, 437 patients with hypertensive intracerebral hemorrhage underwent aspiration surgery. Computed tomography controlled stereotactic aspiration surgery can be performed in hematomas of any site or any stage with minimal tissue damage, even in aged patients. Aspiration surgery led to a favorable clinical experience and outcome, especially in the acute stage.

Gliomatosis cerebri with good prognosis

A 52-year-old man was admitted to our clinic with severe headache and bilateral papilledema. Magnetic resonance (MR) images on admission demonstrated diffuse swelling of the cerebral cortex without formation of a tumor mass. Biopsy revealed diffuse infiltration with neoplastic glial cells. After radiation and chemotherapy, the MR images returned to normal. The morphological and neurological features of the present case met the criteria for gliomatosis cerebri. However, this patient showed an unusually good response to radiation and chemotherapy.

Aspiration Surgery for Hypertensive Brain Hemorrhage in the Acute Stage

Hypertensive brain hemorrhage (HBH) occurs most commonly in the basal ganglia, the subcortex, the thalamus, the pons, and the cerebellum. Although its exact source and pathology are still controversial, it has been considered to be due to the pathological rupture of small arteries resulting from longstanding hypertension. The angiopathy involved has been named lipohyalinosis, hyaline arteriosclerosis, fibrinoid necrosis, or angionecrosis associated with milliary microaneurysm [8]. In many patients, HBH is associated with various complications, such as diabetes mellitus, pulmonary disorders, renal or heart failure, or gastrointestinal bleeding. Besides clinically manifested brain hemorrhage and these complications, we should be aware of other latent hypertensive angiopathies that many provoke additional unfavorable conditions in patients postoperatively.

CT-Controlled Stereotactic Aspiration in Hypertensive Brain Hemorrhage

CT-guided stereotactic aspiration surgery for the evacuation of hypertensive brain hemorrhage (HBH) has been introduced recently. From December, 1980, to April, 1986, we used aspiration surgery in 375 cases of HBH. The 6-month postoperative outcome of aspiration surgery for acute basal-ganglionic hemorrhage was compared with that after conventional surgery of all Japan and those after conservative treatment. In basal-ganglionic hemorrhage, aspiration surgery led to a favorable clinical experience and outcome, providing the possibility of a new avenue of surgical treatment of HBH.

CT findings and prognosis of spontaneous (hypertensive) intracerebral hematoma associated with intraventricular perforation

従来より高血圧性脳内出血で血腫の脳室内穿破をみる例は一般的に予後不良であると考えられがちであった.しかし, なかにはこの考えと矛盾する非常に良好な経過をとる脳室穿破例のあることも経験される.そこで我々は脳室内穿破例でその予後を左右する因子につき, 主としてCT所見を中心として, 自験例をもとに検討した.対象はCTの精度の向上した最近3年間 (昭和53年1月～55年12月) に経験したテント上出血219例中脳室内に血腫の穿破をみた104例 (47%) である.これらについて検討したところでは, 血腫が脳室内穿破をし, 第III, 第IV脳室内に及ぶものでも, それが直接的に予後不良となる原因とはならないようであった.むしろCT上予後不良を示唆する因子は, 1) 血腫径が3×3cm以上の場合, 2) 急性脳室拡大, 迂廻槽の消失, 血腫の視床下部進展などが重複してみられた場合, 3) 第III, 第IV脳室内に鋳型血腫がみられた場合, と考えられた.もし, これらの所見がみられない場合は, たとえ脳室内に血腫の一部の流入をみてもそれが予後を直接左右する因子とはならないわけで, したがって, 脳室内の血腫をみることのみでは血腫除去を目的とした脳室ドレナージの適応とはならないと思われた.むしろ脳圧亢進なく, その他一般的臨床症状もよければ, 脳室内に血腫があっても経時的CTにより厳重な観察を行いつつ手術侵襲を避けるべきであろうとの結論をみた.高血圧性脳出血による脳室内穿破例の予後について検討を加え以下の結論を得た.